Abstract
Background: People with diabetes or chronic kidney diseases (CKD) are vulnerable to Covid-19. Our aim in this study was to estimate the fatality rate among people with diabetes or CKD infected by Alpha Covid-19 variant.
 Methods: The authors searched PubMed, Scopus, and Embase from 1/12/2019 to 13/5/2020 to find studies that reported the fatality rate of Alpha Covid-19 variant among patients with diabetes/renal disease. A Random effects model meta-analysis was used to calculate the pooled case fatality rate (CFR). Then, a subgroup analysis was performed according to the sample size to find possible sources of heterogeneity.
 Results: In total, 22 papers were studied for diabetes and 10 papers for CKD. The pooled CFR was estimated at 23% (95% CI: 0.18, 0.28) among diabetes patients and 31% (95% CI: 0.16, 0.48) among renal patients. High heterogeneity was observed among the studies (Diabetes: I^2=94%, t^2=0.0173, P<0.01), (CKD: I^2=69%, t^2=0.0457, P<0.01). The subgroup analysis indicated that the sample size had a significant effect on fatality rate estimation. In the diabetes patients, the pooled CFR of Alpha Covid-19 variant was 40% (95% CI: 22%-58%; I^2=91%, t^2=0.0797, P<0.01) among the studies with the sample size of less than 52 hospitalized patients. In the studies with equal or more than 52 patients, the pooled CFR was 14% (95% CI: 11%-17%; I^2=88%, t^2=0.0048, P<0.01). In addition, in renal patients, the pooled CFR was 62% (95% CI: 0.06%-100%; I^2=85%, t^2=0.3745, P<0.01) in the studies with less than six hospitalized patients, and the pooled CFR was 23% (95% CI: 16%-31%; I^2=0%, t^2=0.00, P=0.58) among studies with more than 6 patients.
 Conclusions: People with either diabetes or CKD and infected with Alpha Covid-19 variant had a higher fatality rate in the general population. More care and vaccination is recommended for these patients. It is recommended that we calculate pooled estimation of the case fatality rate of the other variant of COVID-19 such as Beta, Delta, and Omicron in patients with chronic disease.
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